Ankle Lateral Ligament Injury Assessment
Lateral ankle ligament injury is a common MSK condition representing 85% of ankle injuries and has a high recurrence rate. Persisting post-injury symptoms such as swelling, impaired strength, instability (occasional giving way), and impaired balance responses for more than 12 months following the initial injury is defined as '' Chronic Ankle Instability-CAI''. Up to 70% of patients report developing chronic ankle instability.
The highest incidence of LAS was found for aeroball, basketball, indoor volleyball, field sports and climbing.
A systematic review by Hiller et al reported greater larger talar curve, reduced concentric inversion strength, greater sway when standing on stable surfaces with eyes closed, a more inverted ankle position and decreased foot clearance during gait, and prolonged time to stabilization after a jump.
The Ottawa Ankle Rules are used to determine the need for radiographs in acute ankle injuries. If these rules were positive, the patient/athlete needs an x-ray to rule out fractures.
These rules are as follows:
1-Tenderness on palpation of :
A-posterior edge/dip of lateral malleolus
B-Posterior edge/dip of medial malleolus
C-Base of 5th metatarsal
2-Inability to fully weight-bear for normal 4 steps at time of injury or on examination
- Mechanism of Injury and WB status. If an athlete was injured during a game, a decision has to be made on return to play based on the MOI and WB status.
- Mechanical and postural contributing Factors
- When acute symptoms subside, the Cumberland Ankle Instability Tool can be used to predict the developmenet of CAI. A cut off of higher than 11.5 is unlikely to progress to CAI. A lower score is more likely associated with higher risk of developing CAI.
- Assessment of ligamentous laxity:
- Isometric ankle eversion/abduction
Chronic ankle instability checklist:
Following LAS, a comprehensive assessment of the factors contributing factors can help predict the prognosis. The following is a set of markers that are associated with CAI:
Weight-bearing ankle Dorsiflexion < 34 degrees
Isometric hip abduction strength <34% of body weight
Single-leg balance test <10 seconds and balancing on toes < 5 seconds without unsteadiness.
Unable to complete single leg drop landing test.
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